A new meta-analysis found that about one in 18 patients taking hydroxychloroquine (HCQ) over 15 years will develop retinal damage. The study included a total of about 20,000 patients in 19 datasets. The 15-year cumulative incidence of retinopathy was described in detail. Long-term use of HCQ can lead to retinopathy, which causes severe and progressive vision loss. The risk of toxicity is higher than previously estimated thanks to modern imaging techniques that detect the early stage. HCQ has previously been found to inhibit OATP1A2 in RPE cells, which affects the visual cycle. The retinopathy is bilateral and symmetrical, with initial signs such as macular edema or granular depigmentation of the RPE. Regular ophthalmological examination is recommended for patients on long-term treatment.